Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial

Abstract

The incidence and mortality of primary liver cancer are very high and resection of tumor is the most crucial treatment for it. We aimed to assess the efficacy and safety of combined use of transversus abdominis plane (TAP) block and laryngeal mask airway (LMA) during implementing Enhanced Recovery After Surgery (ERAS) programs for patients with primary liver cancer. This was a prospective, evaluator-blinded, randomized, controlled parallel-arm trial. A total of 96 patients were enrolled (48 in each group). Patients in the control group received general anesthesia with endotracheal intubation, while patients in the TAP + LMA group received general anesthesia with LMA and an ultrasound-guided subcostal TAP block. The primary end-point was postoperative time of readiness for discharge. The secondary end-points were postoperative pain intensity, time to first flatus, quality of recovery (QoR), complications and overall medical cost. Postoperative time of readiness for discharge in the TAP + LMA group [7 (5–11) days] was shorter than that of the control group [8 (5–13) days, P = 0.004]. The postoperative apioid requirement and time to first flatus was lower in the TAP + LMA group [(102.8 ± 12.4) µg, (32.7 ± 5.8) h, respectively] than the control group [(135.7 ± 20.1) µg, P = 0.000; (47.2 ± 7.6) h, P = 0.000; respectively]. The QoR scores were significantly higher in the TAP + LMA group than the control group. The total cost for treatment in the TAP + LMA group [(66,608.4 ± 6,268.4) CNY] was lower than that of the control group [(84,434.0 ± 9,436.2) CNY, P = 0.000]. There was no difference in complications between these two groups. The combined usage of a TAP block and LMA is a simple, safe anesthesia method during implementing ERAS programs for patients with primary liver cancer. It can alleviate surgical stress, accelerate recovery and reduce medical cost.

Efficacy of transversus abdominis plane block in pain control after general abdominal surgery – a short review of the literature

“…Patients in the transversus abdominis plane block group also used fewer opioids during surgery and spent less time in the post-anesthesia care unit. The study concludes that the association between laryngeal mask airway and transversus abdominis plane block is safe and effective as part of the ERAS, it reduces postoperative stress and helps in the recovery process [27].…”

“…Length of hospital stay was another significant parameter followed by the authors, which was less in the target group, compared to the control group (Torgeson M et al [21] and Huang HM et al [27].…”

Pain management, fluid therapy and thromboprophylaxis after pancreatoduodenectomy: a worldwide survey among surgeons

“…Although it has been shown to be beneficial following other upper gastrointestinal resections including hepatectomy and gastrectomy. 18,19 In the survey, 66% of surgeons preferred patient controlled analgesia over continuous infusion. Despite evidence of improved effectiveness and higher patient satisfaction within other fields of surgery 20 , few studies have investigated this in pancreatic surgery.…”

The Effect of Different Types of Laryngeal Mask Airways on Sound Quality: A Prospective Randomized Study

“…SAD is preferred especially in the outpatient setting because it is less traumatic compared to ETI and does not require muscle relaxants. This allows patients to recover quickly and to be discharged early [ 13 , 14 ]. Therefore, there are many SADs available, such as the enhanced classical LMA, ProSeal LMA, and I-gel LMA.…”